A Multi-Encounter Case of Diabetes Care in a Rural Clinic

Abstract

Diabetes mellitus is a growing burden in rural communities, often complicated by limited access to care, poor adherence, and lifestyle barriers. Primary care and rural clinics play a critical role in providing longitudinal, holistic diabetes care. A 62-yearold woman, BJ with type 2 diabetes presented to a rural clinic with poorly controlled blood glucose despite being on metformin 500 mg twice daily. She reported dietary indiscretion, irregular monitoring, and medication non-adherence. Over four encounters spanning three months, interventions included structured counseling on nutrition and exercise, optimization of pharmacotherapy, adherence support, and close follow-up. Therapy was titrated to metformin 1 g twice daily plus glibenclamide 5 mg daily. The client achieved progressive improvement in glycemic control (fasting blood glucose reduced from 232 mg/dL at baseline to 124 mg/dL at three months), adopted healthier dietary practices, improved adherence, and lost weight. This case highlights the effectiveness of multi-encounter diabetes care in a rural clinic. Sustained patient education, lifestyle counseling, and collaborative care significantly improved clinical and lifestyle outcomes in a resource-limited setting.